TitleWeb Select Drug Program® Formulary updates
Professional; Facility; Ancillary
June 1, 2015
Page Content The Select Drug Program Formulary, which is available for commercial
members, is a list of medications approved by the U.S. Food and Drug
Administration that were chosen for formulary coverage based on their medical
effectiveness, safety, and value. The list changes periodically as the Pharmacy
and Therapeutics Committee reviews the formulary to ensure its continued
effectiveness. The most recent changes are listed below.
Generic additions
These generic drugs recently became available in the marketplace. When these
generic drugs became available, we began covering them at the appropriate
generic formulary level of cost-sharing:
Generic drug | Brand drug | Formulary chapter | Effective
date |
amlodipine-valsartan-HCTZ | Exforge HCT®
| 4. Heart, Blood Pressure, & Cholesterol | December 8, 2014
|
celecoxib | Celebrex® | 3. Pain, Nervous
System, & Psych | December 15, 2014 |
clobetasol propionate spray | Clobex® Spray
| 5. Skin Medications | January 5, 2015 |
colchicine | Colcrys® | 9. Bone, Joint, &
Muscle | January 19, 2015 |
colchicine | Mitigare? | 9. Bone, Joint, & Muscle
| January 19, 2015 |
dexmethylphenidate ER | Focalin XR® | 3.
Pain, Nervous System, & Psych | November 17, 2015 |
estradiol | Vivelle-Dot® | 10. Female,
Hormone Replacement, & Birth Control | December 29, 2014 |
guanfacine ER* | Intuniv? | 3. Pain, Nervous System, &
Psych | December 8, 2014 |
ivermectin | Stromectol® | 1. Antibiotics
& Other Drugs Used for Infection | November 17, 2014 |
lamivudine sol | Epivir® Sol | 1.
Antibiotics & Other Drugs Used for Infection | January 12, 2015
|
MB hydrogel | Aurstat® | 5. Skin
Medications | December 8, 2014 |
mycophenolate mofetil susp | Cellcept® Susp
| 2. Cancer & Organ Transplant Drugs | November 24, 2014
|
prednisolone sodium phosphate | Orapred ODT®
| 7. Diabetes, Thyroid, Steroids, & Other Miscellaneous Hormones
| December 15, 2014 |
sirolimus 1 mg, 2 mg tabs | Rapamune® 1 mg, 2 mg
tabs | 2. Cancer & Organ Transplant Drugs | November 3,
2014 |
tacrolimus | Protopic® | 2. Cancer & Organ
Transplant Drugs | December 1, 2014 |
testosterone 1% packet* | Androgel® 1% Packet
| 7. Diabetes, Thyroid, Steroids, & Other Miscellaneous Hormones
| January 5, 2015 |
Urea 47% cream | Keralac® 47% Cream | 5.
Skin Medications | December 1, 2014 |
Uro-L | Urelle® | 1. Antibiotics & Other
Drugs Used for Infection | December 29, 2014 |
Uro-MP | Uribel | 1. Antibiotics & Other Drugs Used for
Infection | December 22, 2014 |
valganciclovir | Valcyte® | 1. Antibiotics
& Other Drugs Used for Infection | December 8, 2014 |
| | | |
*Generic requires prior
authorization.
Brand additions
These brand drugs were added to the formulary as of the date indicated below
and are covered at the appropriate brand formulary level of cost-sharing:
Brand drug | Generic drug | Formulary chapter | Effective date |
Harvoni® | Not available | 1. Antibiotics
& Other Drugs Used for Infection | April 1, 2015 |
Invokamet® | Not available | 7. Diabetes,
Thyroid, Steroids, & Other Miscellaneous Hormones | June 1, 2015
|
Invokana® | Not available | 7. Diabetes,
Thyroid, Steroids, & Other Miscellaneous Hormones | June 1, 2015
|
Suboxone® Film* | Not available | 3. Pain,
Nervous System, & Psych | June 1, 2015 |
*Covered at the appropriate
generic formulary level of cost-sharing.
Brand deletions
Effective July 1, 2015, these brand drugs will be covered
at the appropriate non-formulary level of cost-sharing:
Brand drug | Generic drug | Formulary chapter |
Androgel® 1% Packet | testosterone 1% packet
| 7. Diabetes, Thyroid, Steroids, & Other Miscellaneous Hormones
|
Celebrex® | celecoxib | 3. Pain, Nervous
System, & Psych |
Cellcept® Susp | mycophenolate mofetil susp
| 2. Cancer & Organ Transplant Drugs |
Clobex® Spray | clobetasol propionate spray
| 5. Skin Medications |
Colcrys® | colchicine | 9. Bone, Joint, &
Muscle |
Rapamune® 1 mg, 2 mg tabs | sirolimus 1 mg, 2 mg
tabs | 2. Cancer & Organ Transplant Drugs |
Valcyte® | valganciclovir | 1. Antibiotics
& Other Drugs Used for Infection |
Vivelle-Dot® | estradiol | 10. Female,
Hormone Replacement, & Birth Control |
The generic drugs for the above brand drugs are on our formulary and
available at the generic formulary level of cost-sharing.
Effective July 1, 2015, Effective July 1, 2015, this brand
drug will be covered at the appropriate non-formulary level of cost-sharing:
Brand drug | Generic drug | Formulary chapter |
Blephamide® Susp | sulfacetamide/prednisolone
susp | 11. Eye Medications |
There is no generic equivalent for the above brand drug; however, there is a
formulary therapeutic alternative drug. This therapeutic alternative drug is
available at the appropriate formulary level of cost-sharing. We encourage you
to discuss formulary alternatives with your patients.
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